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Vol 69, No 2 (2018)
Case report
Submitted: 2017-02-08
Accepted: 2017-04-24
Published online: 2018-02-08
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Milk-alkali syndrome (MAS) as a complication of the treatment of hypoparathyroidism — a case study

Agata Skwarek, Janusz Pachucki, Tomasz Bednarczuk, Zuzanna Żurecka, Michał Popow, Agnieszka Kondracka1, Zbigniew Bartoszewicz1
DOI: 10.5603/EP.a2018.0015
·
Pubmed: 29442351
·
Endokrynol Pol 2018;69(2):200-204.
Affiliations
  1. Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Warsaw, Poland, Poland

open access

Vol 69, No 2 (2018)
Case report
Submitted: 2017-02-08
Accepted: 2017-04-24
Published online: 2018-02-08

Abstract

Milk-alkali syndrome (MAS), characterized by renal failure, metabolic alkalosis and hypercalcemia, is a severe and life-threatening complication of the treatment of hypoparathyroidism. The clinical course is often sudden and is not preceded by any prodromal symptoms. Occurrence does not depend on the duration of hypoparathyroidism treatment, although it is closely related to the applied therapy, especially the dose of calcium carbonate and active vitamin D preparations. Drugs influencing the glomerular filtration rate (angiotensin receptor blockers, sartans, aldosterone receptor antagonists, thiazide diuretics), lack of adequate routine control, changing the calcium carbonate supplementation, dehydration, a diet rich in pH-basic foods (i.e. vegetarian diet), pregnancy and other associated conditions are listed among the factors triggering MAS. A higher calcium carbonate dose is directly associated with an increased risk of milk-alkali syndrome. In case of a high calcium demand it is necessary to control renal function and monitor the level of calcium in the serum more frequently, aiming for the lower end of the reference range. If MAS has been confirmed or if there are alarming neurological symptoms suggestive of hypercalcemia, the patient must be sent to the hospital immediately. Treatment of MAS involves: discontinuation of calcium and vitamin D supplementation, and intravenous infusion of normal saline solution to eliminate volume deficiencies and to achieve forced diuresis while maintaining proper fluid balance. As soon as there is improvement in the patient’s clinical condition, it is necessary to begin the treatment of comorbidities increasing the risk of renal failure or alkalosis (i.e. vomiting, diarrhea).

Abstract

Milk-alkali syndrome (MAS), characterized by renal failure, metabolic alkalosis and hypercalcemia, is a severe and life-threatening complication of the treatment of hypoparathyroidism. The clinical course is often sudden and is not preceded by any prodromal symptoms. Occurrence does not depend on the duration of hypoparathyroidism treatment, although it is closely related to the applied therapy, especially the dose of calcium carbonate and active vitamin D preparations. Drugs influencing the glomerular filtration rate (angiotensin receptor blockers, sartans, aldosterone receptor antagonists, thiazide diuretics), lack of adequate routine control, changing the calcium carbonate supplementation, dehydration, a diet rich in pH-basic foods (i.e. vegetarian diet), pregnancy and other associated conditions are listed among the factors triggering MAS. A higher calcium carbonate dose is directly associated with an increased risk of milk-alkali syndrome. In case of a high calcium demand it is necessary to control renal function and monitor the level of calcium in the serum more frequently, aiming for the lower end of the reference range. If MAS has been confirmed or if there are alarming neurological symptoms suggestive of hypercalcemia, the patient must be sent to the hospital immediately. Treatment of MAS involves: discontinuation of calcium and vitamin D supplementation, and intravenous infusion of normal saline solution to eliminate volume deficiencies and to achieve forced diuresis while maintaining proper fluid balance. As soon as there is improvement in the patient’s clinical condition, it is necessary to begin the treatment of comorbidities increasing the risk of renal failure or alkalosis (i.e. vomiting, diarrhea).

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Keywords

MAS, hypercalcemia, hypoparathyroidism, alkalinisation, hypercalciuria, milk alkali syndrome, metabolic alkalosis, renal failure, active vitamin D

About this article
Title

Milk-alkali syndrome (MAS) as a complication of the treatment of hypoparathyroidism — a case study

Journal

Endokrynologia Polska

Issue

Vol 69, No 2 (2018)

Article type

Case report

Pages

200-204

Published online

2018-02-08

Page views

3268

Article views/downloads

2418

DOI

10.5603/EP.a2018.0015

Pubmed

29442351

Bibliographic record

Endokrynol Pol 2018;69(2):200-204.

Keywords

MAS
hypercalcemia
hypoparathyroidism
alkalinisation
hypercalciuria
milk alkali syndrome
metabolic alkalosis
renal failure
active vitamin D

Authors

Agata Skwarek
Janusz Pachucki
Tomasz Bednarczuk
Zuzanna Żurecka
Michał Popow
Agnieszka Kondracka
Zbigniew Bartoszewicz

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